Before the ACA in most states low-income women could be covered by
Medicaid only if they were pregnant or disabled, if they had kids younger than
18, or were over 65. If they didn't fall into these categories they weren't
covered. Even mothers whose kids might qualify for Medicaid often couldn't get it
for themselves.

The original idea
was to require all states to have expanded Medicaid, a federally funded program
that allowed coverage not only for kids, the disables, and pregnant women, but for
nearly any adult whose income was 138% of the poverty level ($15,800 in 2017)
or below. Above that level, subsidies and tax credits would allow people to
purchase private health insurance on the exchange.

However, the
Supreme Court pushed back against the requirement that all states should have
expanded Medicaid.As a result, 19
states rejected it, so the old Medicaid rules generally still hold in these states. Here, most adults, even single mothers,
aren't insured unless their poverty levels are abysmal. On average in states
that did not take expanded Medicaid, on average, she can't be covered by
Medicaid until her income falls below 44% of the poverty level. (All kids are
covered under a special program that no one is touching so far.*)But it gets worse in specific states.

Examples of
Non-Expanded and Expanded Medicaid in Two States

Let's look at two states: one that takes funding for expanded Medicaid
(New York) and one that does not (Texas), using an example of a single mother
with two kids.

If a single adult isn't eligible for Medicaid -- regardless of whether she's in an expanded
state or not -- and her income
falls below 400% of the federal poverty level ($47,550) she can qualify for tax
credits on the health exchange marketplace. In a 2014 survey nearly
all women in the health market place fell into this category. About
three-quarters of women have income levels below 250% ($29,700), in which cases
out of pocket costs may be limited or eliminated.

Covered Benefits
for Women

Under Medicaid.Twenty-eight states have established programs
that use Medicaid funds to cover the costs of family planning services,
although not abortions, and most states have limited Medicaid programs to pay
for breast and cervical cancer treatment for low-income women.

The Impact of the GOP American Health Care
Act.Under the GOP bill within a few years no
Medicaid plan would have to cover any of the benefits now funded under the ACA.
The GOP bill would also defund Planned Parenthood specifically, whose health
centers provide care to 2.5
million patients, many of whom are on Medicaid and many who live in areas
that have no other source of preventive care.Finally,
as introduced, AHCA includes no less than four abortion coverage
restrictions that, combined, would effectively end coverage in the individual
health insurance market and would undermine coverage in employer-sponsored
insurance plans.

·He has voted to terminate a program that
subsidizes contraception for low-income women. And he really hates the
Affordable Care Act regulation that requires insurance plans to cover
contraception without a co-pay.

He can get rid of this and other benefits by issuing a sweeping
exemption” or he could “get rid of the requirements altogether. All he has to do is redefine
"preventive care" and knock out reimbursement for any benefits
he wants, including birth control.

The ACA isn't perfect.It must be noted that although the rate of
uninsured women dropped after the ACA from 17% to 11% by 2015, 11.2
million women under 65 still remained uninsured, mostly comprising
low-income, immigrant, and minority women, and single mothers. There are still
too many women not being covered and premiums and deductibles are still too
high for too many.But it's a path for
women.whereas( And ) the GOP plan is a cliff. And Tom Price, along with
the rest of Republicans, would like to push a lot of women over it.

About Us

Carol Peckham has spent over 30 years in medical publishing. At the start of this career, she served as Publisher of Scientific American Medicine as a Vice President of Scientific American, Inc. After 15 years, she left to start her own company, Nidus Information Services, where she and her partner launched Well-Connected, a series of 103 in-depth white papers for patients, available in print and on the Internet. After 10 years, they sold their company, and subsequently joined Medscape, the professional arm of WebMD. Peckham served as Director of Editorial Development for another decade. She is now retired and living near Hudson, NY, where she has become active in encouraging universal health care.